Many healthcare challenges in LMICs have remained unsolved for a long time. In Part 1, it became clear that innovations able to translate effectively to low-resource healthcare contexts could offer them a lifeline, both in this crisis and in the foreseeable future. Indeed, in response to outbreaks of COVID-19 in Africa, the WHO called for the exploration of the use of innovative and low-cost interventions [15].

So, from a healthcare perspective, LMICs are both where innovation is needed most and equally where the frugal, elegant, and rapidly mobilised technologies supporting HIC healthcare systems in this crisis originated. There is something we as innovators must learn from this to ensure a truly global response to crises such as pandemics. Firstly, reverse innovation should be viewed as the process of adopting the best innovation, from wherever it arises. But most importantly, innovators, wherever they come from, must start embedding equitable access to their crisis-critical innovations from the start of the design process, to ensure that healthcare services in LMICs get timely access to them.

How can we as innovators ensure LMICs and HICs benefit mutually from our creations?

Designs created must be tailored for successful dissemination in LMICs, which necessitates performing contextual research early in the development process, considering training and usability as well as the distribution and healthcare architectures in LMICs [16]. For example, innovations might make use of the fact that mobile technology is widespread throughout healthcare settings in LMICs [17], or that 3D printing could be used to fabricate emergency medical supplies in remote areas where no manufacturer will deliver.

A simple way of obtaining contextual information is through collaboration with LMIC stakeholders in all design phases – from need identification to dissemination - and the implementation of frugal innovation principles. There are several useful resources to guide innovators in this process, such as https://www.designforhealth.org/, supported by USAID and the Bill and Melinda Gates Foundation, and the Four-Phase Roadmap developed at Delft University [18]. There are also communities of global innovators to draw support from – global ‘collaboratories’ such as RAEng (https://www.raeng.org.uk/global) and Helpful Engineering (https://www.helpfulengineering.org/), as well as Global Health research groups funded by the UK’s National Institute for Health Research (NIHR) (https://www.nihr.ac.uk/explore-nihr/funding-programmes/global-health/).

While not a trivial process, consideration of and collaboration with LMIC stakeholders during innovation development is critical to realise high quality, disruptive innovations, like OneBreath Ventilators (http://www.onebreathventilators.com/), based in Bangalore, India, and ShiftLabs’ DripAssist (https://www.shiftlabs.com/), developed in response to the Ebola epidemic.

Figure 3: ShiftLab’s DripAssist [19]

Whether in times of global or local crises, these are the innovations changing healthcare systems in high-income and low-income countries alike. By considering the needs of LMICs, these innovators have not only ensured a long-term, sustainable market for their innovations in both HICs and LMICs, but they have saved countless lives in the process. With this priceless mutual benefit on offer, we innovators must embrace this approach, for ensuring the positive impact of our creations transcends the COVID-19 crisis, and lays the foundations for a new era of truly global healthcare innovation.